Organization
LOVE DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDA JEAN TAYLOR D.M.D. (DENTIST/OWNER)
(773) 568-1600
Entity
Organization
Contact information
Practice address
11139 S HALSTED ST, CHICAGO, IL 60628-3910
(773) 568-1600
(773) 568-1603
Mailing address
11139 S HALSTED ST, CHICAGO, IL 60628-3910
(773) 568-1600
(773) 568-1603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019023707
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019023707
—
IL
05
—
1144540782
—
IL
Enumeration date
06/06/2010
Last updated
10/10/2016
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